Working to change our understanding of mental health disorders and the approach to treating them.
Working to reduce stigma and promote acceptance.
Teaching positive ways to a better life and mind, to a better mind and life.

Friday, March 27, 2015

Plane Crashes, Why, Black Swans and Mental Illness Stigma

This will be very brief as the news story of the crash of Germanwings flight 4U9525 two days prior to this writing is very much at the fast breaking stage which at this point appears to be not an accident but instead something the co-pilot planned and carried out.

First of all, this is unquestionably different from a normal air crash. Losing family, friends and loved ones in any accident is very difficult to cope with; if it does indeed prove that this was a deliberate act, there is no doubt this will make it all the more difficult to accept and cope with. I of course feel great empathy for those who lost family, friends, colleagues and loved ones in this tragedy.

However, at this point all is conjecture. Any major airline crash investigation will take at least a year or more and given the unusual circumstances of this incident, this case could take much longer. Anything, therefore, one reads in headlines and news stories in these very early stages will be pure speculation and conjecture, however factual it may appear to be at this time. As well, whatever the facts may be, it will take the full length of the investigation to establish what facts played what role in this tragedy. So not only have facts not as yet been firmly established, investigators have not even begun to go through them and link any given prior fact to its role in the outcome. In other words, it is simply not possible for anyone - no matter how authoritive or close to the case - to draw any conclusions at this time. I therefore ask anyone reading here to please refrain from unfounded speculation and the drawing of any conclusion and remind that you are neither qualified to do so nor to understand the facts in this case as they come to light.

* * * * *

News reports are now emerging that the co-pilot had received treatment for "depression" six years ago. Via Reuters:

The pilot who appears to have deliberately crashed a plane carrying
149 others into the French Alps received psychiatric treatment for a
“serious depressive episode” six years ago, German tabloid Bild reported
on Friday.

Citing internal documents and Lufthansa
sources, Bild said Lubitz spent a total of one and a half years in
psychiatric treatment and that the relevant documents would be passed to
French investigators once they had been examined by German authorities.

What does this mean? At this point it is very easy to jump to conclusions, however readily "apparent" they may be to those not trained to understand either mental health disorders or what roles they play in human behaviour. Again, any link at this point to the copilot's past mental health issues and this incident is pure conjecture. But lets look to understand what if it played a role. There are two basic issues here. One is an airline crash, the other is someone with a mental health disorder performing acts on this magnitude. Air crashes are exceedingly rare in today's age. Air crashes involving deliberate actions by either the pilot or copilot are exceedingly rare among total crash statistics. Which makes this a Black Swan Event.

Black Swan Events

The black swan theory or theory of black swan events is a metaphor that describes an event that comes as a surprise, has a major effect,
and is often inappropriately rationalized after the fact with the
benefit of hindsightThe theory was developed by Nassim Nicholas Taleb to explain:

The disproportionate role of high-profile, hard-to-predict, and rare
events that are beyond the realm of normal expectations in history,
science, finance, and technology.

The non-computability of the probability of the consequential rare
events using scientific methods (owing to the very nature of small
probabilities).

The psychological
biases that make people individually and collectively blind to
uncertainty and unaware of the massive role of the rare event in
historical affairs.

This incident clearly scores on all three counts:Point one is self-explanatory.Point two. An incident of this nature is obviously very hard to compute; for all intents and purposes computing the probability of something like this virtually impossible. Point three is of most interest to us here.

This is a classic black swan event in that the magnitude of the incident that sears into people's minds blows out of all proportions the probability of it happening again. Psychological biases are also a form of cognitive distortions. Cognitive distortions are irrational thought processes that create undo anxiety and fear. They are considered irrational because there is no logical or factual basis for them. As I see things developing in this case, I can see two irrational fears taking root in people's minds:- Fear of flying- Fear of those with mental illnesses and resultant increase in stigmatization against them. First of all, let's address the safety of airline travel. Airline travel continues to improve in safety and set all time safety records in 2011, '12 and again in '13.

In terms of casualties to passengers carried, that ratio has been steadily improving for four decades.

This incident does nothing to change that. Given the purpose and nature of this blog, we now get to the real point:As soon as I saw the news reports about the co-pilot's prior mental health condition and year and a half of treatment, I knew that this could do for mental health suffers and the stigmatization thereof what 9/11 did for the stigmatization of and prejudice against Muslims. Not on the same scale of course, but given the already dreadfully and widespread ignorance of and stigmatization of those with mental health disorders, this has all the potential to further distort in the minds of most that mental health disorders lead to violence, incompetence and other erroneous ill founded conclusions, much to the detriment and improved mental health of those with any ongoing or past history of living with a disorder.

Stigma against mental illness has devastating consequences for
individuals with mental illness and their families. Empirical findings
and qualitative evidence indicate that stigma against mental illness
remains rampant in many nations and cultures, constituting a significant
barrier to successful treatment, reducing key life opportunities, and
predicting poor outcomes over and above the effects of mental illness
per se.

In this article we define stigma, examine relevant theoretical
perspectives, summarise evidence regarding the pervasive negative impact
of stigma on individuals with mental illness, and discuss underlying
mechanisms. We focus in particular on assessment issues, highlighting
the need for transcending explicit attitudinal measures of stigma, which
are susceptible to social desirability concerns and are likely to
underestimate true levels of stigma, to include unconscious/implicit
indicators and direct behavioural appraisals. A primary goal is to
facilitate means of accurately measuring stigma against mental illness
as an important step toward reducing its pernicious effects.

Aside from a person's inner struggles, stigma will be the worst thing the sufferer of a psychiatric disorder will endure. In fact, I'll argue at a future point in this blog (and book), it may become the most defining factor in the long term outcome of their given disorder. Along with substance abusers and the homeless, mental illness sufferers are already one of the three most stigmatized demographic groups in the Western world according to experts in the field (1). What role did the mental health of the pilot play in this tragedy?In truth, at this point we have absolutely no idea. As I said, an investigation into this incident will take a year or more. And even if it does prove to have played a role, what does this mean?Essentially nothing. Again, it is a black swan event, an event of such low statistical probability it is virtually meaningless. Look, tens of millions of people around the world live with a mental health disorder. Again, the percentages of them or probability of them (or us, to my readers) performing an act like this is so statistically improbable as to have no practical bearing on society's outlook on mental health disorders whatsoever. But linking an event like this to people's perception of a given demographic group is exactly what happens. People leap to conclusions. They see a tragedy like this, the loss of life, the pain of those who lost family and loved ones and the immediate urge is to appoint blame.And one of the greatest faults of the human brain is that it wants to appoint blame to a "them" group so as to make their own group feel better and more secure about themselves. Which is what I see happening here already. Perhaps consciously, more likely unconsciously as this link between "depression", "mental illness" and this event gets burned into their minds by 24/7 sensationalized news coverage. This event is already a great tragedy. And I understand people's need to make sense out of something like this, an incident that if is ultimately to have been proven true (a deliberate crash) is beyond our grasp to understand. But sometimes there just is no why. Sometimes there just is no knowable answer, no satisfying answer. And this is what creates fear - not knowing. Which is why we must apply a "black swan" explanation; there is no real answer but the occurance of the incident is so out of the ordinary, so improbable, that we must just let go of ever having an answer, let go of the fear of it happening again.

Meanwhile, to appoint blame to an entire demographic (those with a mental illness designation) - and thus further perpetrate stigma against that group - based on irrational conclusions and statistical improbabilities would be a worse - and much greater far reaching - tragedy. (1) Citation source coming

1 comment:

Great post. We do need to find something to point to, preferably just one thing to blame. To say that there are many factors that contribute or worse, no factors sends people's minds reeling.

With regards to labelling, it's almost as though a fuse blows and the person is stigmatized forever as X, where X could be mentally ill, drug-addicted, or non-violently criminal. And as such there's no interest in trying to reverse their 'condition' by spending public funds. The attitude is that they've shown their true colors.

About Me

I study neuroscience, cognitive neuroscience, human behaviour and certain neuropsychiatric disorders. I am currently working on a book summarizing much of what I believe are the most relevant brain abnormalities involved in neuropsychiatric disorders along with my own views and considerable insights.

Aside from that, I continue to pursue photography. Currently, I am working on a project involving female faces and various shapes and colours that I find interesting. Some of my previous photography is up on my website. Only a tiny fraction is up on the site (because of <ahem> "hard drive issues") but it gives some idea of what I do with a camera and the right lenses.

These two pursuits, along with great interests in music, cooking and baking, looking after Mrs Bean (and she after me) and following various sports (particularly baseball) keeps me more than busy enough.